Director Medicaid Operations and Compliance

Health Net, Inc. (NYSE: HNT) is among the nation's largest publicly traded managed health care companies. Health Net's mission is to help people be healthy, secure and comfortable. The company's POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals. For more information on Health Net, Inc., please visit the company's Web site at www.healthnet.com

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JOB SUMMARY:

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Reporting to the VP Medicaid Programs, the Director, Medicaid Operations & Compliance is responsible for overseeing ongoing contractual compliance with the Northeast State Medicaid contracts as well as ensuring Medicaid program operational processes and outcomes in accordance with federal and statutory requirements.? Additionally, the director serves as Plan representative with regulatory agencies, responding to all compliance and operational issues and concerns.

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ESSENTIAL DUTIES AND RESPONSIBILITIES:

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1.?????Directs the development, implementation and ongoing operations of Medicaid Programs for the Northeast.? Develops and implements operational strategies designed to ensure cohesive Medicaid-related processes throughout Health Net that are compliant with all Northeast state Medicaid contractual as well as federal and statutory requirements.?

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2.?????Serves as program liaison for state regulators (or their agents) with respect to contractual compliance, ongoing operational activities, issues or concerns.? Communicates all program-related items as appropriate throughout the organization, ensuring effective communications with the State regulators as well as internal management and associates.

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3.?????Directs and oversees ongoing operational activities within the Medicaid unit.? Provides guidance and oversight for outreach and marketing strategies and activities, ensuring compliance with state marketing guidelines, while attaining membership growth and retention goals. Ensures compliance when addressing regulatory complaints, grievances and all reporting requirements.?? Ensures timely and accurate reporting compliance as well as interacts with functional management to provide insightful analytics regarding reported activity including root cause analysis and solution development

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4.?????Together with Medicaid management team, serves as program resource and subject matter expert with regards to all Medicaid program activities throughout the organization.?? Provides guidance, contract requirement interpretation as well as collaboration with respect to Medicaid activities and performance.

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5.?????Plans and directs the hiring, supervision, training and professional development of staff.? Develops individual performance objectives and evaluates staff performance against those stated objectives.? Provides verbal and written feedback to staff relative to job performance.

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6.?????Other assignments and responsibilities as requested by Management.



REQUIREMENTS:

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Education:

Bachelor's degree in health care management or administration (or related field) is required.?? Master's degree in relevant field is strongly preferred.?

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Certification/License:

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Experience:

Minimum of five years management-level experience working in a managed-care environment is required (government program experience strongly preferred).? Preferred areas of experience include compliance or operations.

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Knowledge, Skills & Abilities:

Must be a self-motivated individual driven to excel with a proven ability to effectively lead and motivate a team as well as work effectively and contribute productively as a team member.

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Exceptional interpersonal skills are required to effectively interact with state regulators and collaborate with management and associates throughout the Plan with respect to Medicaid activities and operations.

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Excellent analytical, communication (written & verbal), project management and problem-solving skills are required.

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Ability to travel within the region is required.

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OR
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.

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Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.

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Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.